Navigating the health care maze

Representative Henry Waxman (D-CA) speak during a news conference calling for no reduction in the Medicare and Medicaid budgets, as part of the year end budget talks on Capitol Hill in Washington on Dec. 11. Photo by REUTERS/Joshua Roberts

Congressman Henry Waxman’s granddaughter recently introduced him to the acronym “YOLO.” It stands for “You Only Live Once” and is often used by young people as a justification to take chances.

Telling the story last month to a roomful of sympathetic seniors, the Democratic congressman from Los Angeles lamented the recklessness of young people, reminding the audience of the importance of convincing their younger relatives to buy health insurance, even when they think they will not need it for a while.

“A lot of young people think nothing will ever happen to them,” Waxman said. “You can have an accident; things can happen to you, even if you’re young.”

But that was only part of Waxman’s message when he addressed about 30 seniors on June 3 at the Jewish Family Service Freda Mohr Multipurpose Center on North Fairfax Avenue in an attempt to help them understand upcoming changes to their health care with the implementation of the Affordable Care Act (ACA), through which people may apply for health insurance through a new exchange, beginning Oct. 1.

“We have to broaden the number of people who buy insurance,” Waxman said. “We all have to be part of the system … otherwise it won’t work.”

The legislation, signed by President Barack Obama in March 2010, mandates that nearly everyone, including young people, have health insurance beginning in 2014. In the process, it intends to lower the cost of obtaining health insurance, which would benefit seniors, Waxman said.

Because many people in the United States obtain coverage through their jobs, President Lyndon B. Johnson oversaw the creation of Medicare and Medicaid in 1965, national programs to ensure health care to those who often fell through the cracks — seniors and low-income citizens, respectively.

But the longstanding system is far from perfect, Waxman said, “We have many gaps where Americans have fallen through,” referring to the unemployed, seniors and people whose jobs do not provide them with adequate health insurance.

His audience, which included some people in their 80s and 90s, nodded with recognition when Waxman described the problems of attempting to pass comprehensive health care legislation. At the end of his hour-long speech, one man stood up to ask, “Why is that many poorer counties, England, Israel, Sweden, can afford Medicare for all?”

Waxman called the ACA a “good, but not perfect” solution. The ACA is meant to spur competition among private insurance companies in hopes of lowering prices for consumers, Waxman said. It achieves this by widening the insurance pool through establishing “market exchanges,” also called health insurance marketplaces, in which businesses with fewer than 100 employees can pool their employees together in one insurance group, allowing them to be eligible for competitive rates. These “marketplaces” can also be used by individuals.

Although about 95 percent of large businesses provide their employees with insurance, small businesses do not because of costs. A law requiring that businesses with 50 or more full-time employees provide insurance options that had been scheduled to be instituted by the end of the year was just delayed a year by the Obama administration in order to provide more time for those businesses to accommodate.

Waxman said that despite some resistance among small-business owners, many of those he has talked to have by now accepted it.

Many Republicans, among many objections to the ACA, have predicted that replacing the current system of health care with the new approach will only increase costs to patients, according to Dr. Charles Boustany, a Republican congressman from Louisiana, who delivered an official response to Obama’s congressional address in 2009. Although Republican leaders agree that rising health care costs must be addressed, they say the ACA will exacerbate the national debt and argue that it could destroy jobs by taxing job creators.

There are other changes, too, as a result of the comprehensive health reform legislation that may be of particular interest to seniors. Beginning in 2014, for example, insurance companies must provide insurance for all applicants, regardless of pre-existing conditions, and cannot charge those people higher rates.

Medicare also will offer free yearly check-ups. “We want to keep people healthy rather than just paying for them when they are sick,” Waxman said.

Waxman also briefly mentioned how the ACA will remedy the “donut hole,” or the lapse in coverage Medicare recipients reach when they have spent over a certain amount on prescription drugs. By 2020, according to a 2012 report by the Centers for Medicare & Medicaid Services, this coverage gap will be nonexistent.

Paul Castro, CEO of JFS, said the event was part of a larger effort on the part of the agency to help its clientele prepare for and adjust to the changes in their health care.

JFS already provides services to help seniors manage their medical care, including delivering meals to people who have been released from the hospital and providing counseling to help them cope with their experiences. These practices help prevent patients from being readmitted for expensive hospital stays after being discharged, he said.

Now the staff at JFS is devoted to helping its clientele adjust to changes in both federal and California health care policies, which can be confusing and overwhelming.

“You can imagine how this gets exacerbated when you are 88 years old,” Castro said.

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